Names and pronunciation
(nor-ep-i-nef′rin) Levophed
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Drug reference
(nor-ep-i-nef′rin) Levophed
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Func. class.: Adrenergic N
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Chem. class.: Catecholamine
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Do not confuse: norepinephrine/EPINEPHrine
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ACTION: Causes increased contractil- ity and heart rate by acting on β-receptors in heart; also acts on α-receptors, thereby causing vasoconstriction in blood vessels; B/P is elevated, coronary blood flow improves, and cardiac output increases
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USES: Acute hypotension, shock
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CONTRAINDICATIONS: Hyper- sensitivity to this product or cyclopro- pane/halothane anesthesia, hypovolemia, mesenteric thrombosis Precautions: Pregnancy, breastfeeding, geriatric patients, arterial embolism, peripheral vascular disease, hyperten- sion, hyperthyroidism, cardiac disease, ventricular fibrillation, tachydysrhyth- mias, pheochromocytoma, hypotension, sulfite hypersensitivity
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Black Box Warning: Extravasation Black Box Warning: Extravasation: inj site: tissue sloughing; change injection sites if blanching or vasoconstriction occurs • Sulfite sensitivity, which may be life- threatening • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding
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SIDE EFFECTS CNS: Headache, anxiety, dizziness, insomnia, restlessness, tremor, cerebral hemorrhage CV: Palpitations, tachycardia, hyper- tension, ectopic beats, angina GI: Nausea, vomiting GU: Decreased urine output INTEG: Necrosis, tissue sloughing with extravasation, gangrene RESP: Dyspnea SYST: Anaphylaxis
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INTERACTIONS • Do not use within 2 wk of MAOIs, an- tihistamines, ergots, methyldopa, oxy- tocics, tricyclics because hypertensive crisis may result Increase: B/P—oxytocics Increase: pressor effect—tricyclics, MAOIs Decrease: norepinephrine action— α-blockers
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TREATMENT OF OVERDOSE: Administer fluids, electrolyte replacement
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DOSAGE AND ROUTES • Adult: IV INFUSION 0.5-1 mcg/min titrated to B/P; maintenance 2-4 mcg/ min; max 30 mcg/min • Child: IV INFUSION 0.1 mcg/kg/min titrated to B/P; max 2 mcg/kg/min
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Available forms: Inj 1 mg/mL
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Administer: Plasma expanders for hypovolemia; cor- rect volume depletion before starting treatment Continuous IV INFUSION route • Dilute with 500-1000 mL D5W or D5/0.9% NaCl; average dilution 4 mg/1000 mL diluent (4 mcg base/mL); give as infusion 2-3 mL/min; titrate to response; discontinue gradually • Store reconstituted sol in refrigerator ≤24 hr, protect from light, store un- opened product at room temperature, do not use discolored sol Y-site compatibilities: Alemtuzumab, alfen- tanil, amikacin, amiodarone, anidulafun- gin, argatroban, ascorbic acid, atenolol, atracurium, atropine, aztreonam, benztro- pine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspo- fungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoperazone, cefo- taxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephalothin, chlorampheni- col, chlorproMAZINE, cimetidine, cisatra- curium, CISplatin, clindamycin, cloNI- Dine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DAPTOmycin, dexamethasone, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxy- cycline, enalaprilat, ePHEDrine, EPINEPH- rine, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etoposide, famoti- dine, fenoldopam, fentaNYL, fluconazole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmor- phone, hydrOXYzine, IDArubicin, ifos- famide, imipenem-cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, lido- caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, meropenem, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDA- ZOLE, mezlocillin, micafungin, micon- azole, midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins injection, mycopheno- late, nafcillin, nalbuphine, naloxone, netilmicin, niCARdipine, nitroglycerin, nitroprusside, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazo- cine, phenylephrine, phytonadione, piper- acillin, piperacillin-tazobactam, polymyxin B, potassium chloride, procainamide, prochlorperazine, promethazine, propo- fol, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, rito- drine, succinylcholine, SUFentanil, tacroli- mus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, tobramycin, tolazo- line, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vin- CRIStine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid
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Assess: • I&O ratio; notify prescriber if output <30 mL/hr • B/P, pulse q2-3min after parenteral route, ECG during administration continuously; if B/P increases, product is decreased, CVP or PWP during infusion if possible • Paresthesias and coldness of extremi- ties; peripheral blood flow may decrease
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Evaluate: • Therapeutic response: increased B/P with stabilization, adequate tissue perfusion
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the reason for product adminis- tration; to report dyspnea, dizziness, chest pain
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PHARMACOKINETICS IV: Onset 1-2 min; metabolized in liver; excreted in urine (inactive metabolites); crosses placenta
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• Adult: IV INFUSION 0.5-1 mcg/min titrated to B/P; maintenance 2-4 mcg/ min; max 30 mcg/min
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